• Clinical science

Vaccination

Abstract

Vaccination is a very effective measure for providing immunity to many infectious diseases. The discovery of vaccines played a central part in the eradication of smallpox and helped significantly reduce the incidence of potentially severe diseases such as poliomyelitis and measles. Live vaccines (attenuated, i.e. non-infective pathogens) or inactivated vaccines (subunits or complete pathogens) are used to achieve active immunization, which enables the host's immune system to build up a sustained immune response to specific pathogens. The immune response may be measured and quantified by assessing the antibody titer. In the event of potential disease (e.g., after exposure to high-risk pathogens), if the immune system is unable to produce sufficient antibodies fast enough, passive immunization can offer immediate short-term protection via direct injection of pooled antibodies for many conditions. Modern vaccines are usually well tolerated, and adverse events are rare. However, the intervals between vaccine administration and possible contraindications must be considered.

For CDC vaccination recommendations, see learning card on immunization schedule.

Definition

  • Vaccine: a product (e.g., dead or weakened organism) that provides immunity from a disease
    • May be administered through injection, orally, or nasally
  • Vaccination: administration of a vaccine that induces immunity against an organism
  • Immunization: the process by which a person becomes protected from a disease
    • Vaccines and recovering from some infections cause immunization

References:[1][2]

Aims of routine immunization

  • Herd immunity: Once a certain percentage of the population has received immunization, non-vaccinated individuals (e.g., children too young to receive vaccination) will also be protected.
  • Eradication of disease
    • High immunization rates over prolonged periods of time can achieve eradication of certain diseases.
    • To date, only two diseases have been eradicated by human efforts: smallpox (1980) and rinderpest (2011).
  • Decrease in incidence and disease-associated risks: The Haemophilus influenzae type b (Hib) vaccine has decreased the number of cases of invasive Hib disease (e.g., pneumonia, bacteremia, meningitis, epiglottitis, infectious arthritis) in children younger than 5 by more than 99%.

Passive vaccination

  • Mechanism of action
    • Preformed antibodies are injected and provide protection against a specific pathogen.
    • Antibodies degrade and titers decrease over time → only temporary protection
  • Indication
  • Application: Vaccines are available for intramuscular as well as for intravenous injection.
  • Combination

References:[2][3][4][5]

Active vaccination

Current vaccination recommendations for the US can be found in the immunization schedule.

References:[2]

Live attenuated vaccines

  • Definition: Modified functioning virus or bacterium. The vaccine has the ability to replicate in the patient's body but does not cause disease.
  • Mechanism of action
    • The immune response is similar to infection with a “wild” pathogen.
    • Specific B-cells against an antigen are formed.
  • Administration
    • Oral vaccine or subcutaneous/intramuscular injection in children > 12 months
    • Not indicated in children < 9 months; (the rotavirus vaccine is an exception, which is first given at 6 weeks of age)
    • Usually lifelong immunization
    • Second dose usually recommended to “catch” non-responders (not as a boost)
    • Multiple live vaccines can be given simultaneously, but if given at different times they should be at least 4 weeks apart to avoid possible interference.
    • May be administered simultaneously with inactivated vaccines
  • Available vaccines
  • Special considerations: Live attenuated vaccines can theoretically revert back to their disease-causing form. However, this has only been observed in the case of the oral polio vaccine.

References:[2][6][7]

Inactivated vaccines

Whole vaccines Fractional vaccines
Protein-based Polysaccharide-based
Description
  • Whole inactivated or dead virus/bacteria
  • Cannot replicate
  • Subunit products of pathogen
  • Toxoids
Available vaccines
Mechanism of action
  • Mostly humoral immune response
  • Number of circulating antibodies decreases over time
  • Polysaccharides induce a relative T cell-independent B-cell response and therefore achieve sufficient immunization only in adults and older children.

  • In conjugate vaccines, the carrier protein activates T-cells, which stimulate a more rapid and long-lasting immune response, especially in infants and toddlers.
Special considerations
  • Not consistently immunogenic in infants
Administration
  • Usually injected into the deltoid muscle (alternatively, e.g., in infants, injected into the vastus lateralis muscle)
  • First dose does not provide protective immunity
  • Multiple doses required
  • Periodic “boosts” necessary to insure sufficiently high antibody titers
  • Inactivated vaccines may generally be combined with other vaccines without any time interval in between

References:[2][8][9]

Adverse effects of immunization

  • Common adverse effects
    • Affects ∼ 1/3
    • Usually begin within the first 48–72 hours after administration and last 1–2 days
    • Symptoms
      • Local swelling, redness, and pain at the injection site
      • Low-grade fever
      • Headaches
      • Tiredness
      • Flu-like symptoms
    • Live attenuated vaccine: can cause mild form of the disease, usually appearing within 1–3 weeks of administration; : usually caused by replication of the attenuated vaccine strain
  • Rare adverse effects

There is no link between autism and vaccines or their ingredients!

References:[10][11][12][13][14]

Contraindications for vaccination

References:[15][16][17][18]